by: Begley Law Group

by Thomas D. Begley, Jr., Esquire, CELA

Many personal injury victims require home care for an extended period of time, and in many instances for the rest of their lives.  Most people would prefer to stay in their own homes, but to do so requires care sometimes for a few hours a day and other times 24/7.  The assistance required often involves household chores, nursing services and personal care.  In this area a home health aide from an agency generally costs about $28 per hour.  According to Genworth, the national average bill for a home health aide is $4,385 per month.

Five Ways to Pay

There are only five ways to pay for home health care.

  • Private Pay. Most home health care is paid for out-of-pocket.  This is painful and most people run out of money fairly quickly.  According to Jerry Love, a certified public accounts and frequent lecturer for the American Institute of Certified Public Accountants, many people requiring home care cobble a budget from multiple sources including:
  • Annuities;
  • Investment savings;
  • Life insurance policies; and
  • Borrowing through Reverse Mortgages or Home Equity Loans.

Individuals who pay privately for home care do usually qualify for an income tax deduction for a medical expense.

  • Long-Term Care Insurance. Most long-term care insurance policies pay for home care, but only 8% of Americans have long-term care insurance.
  • Medicare pays for home care, but only if the care is skilled an intermittent.  This is limited to about two days per week for a few hours each day.  Medicare will not pay for full-time home care or personal or homemaker services.  Medicare Advantage Plans often provide some personal care aide services, even if the recipient does not need therapy or skilled nursing.  Physical Therapy, Occupational Therapy, and Speech Language Pathology Services are also included under Medicare.  Medicare does not pay for 24-hour a day care at home, meals delivered to the home, or homemaker services such as shopping, cleaning and laundry, or custodial or personal care services such as bathing, dressing or toileting when this is the only care required.
  • Veterans Administration. The Veterans Administration offers programs that will pay for home care or provide a cash allotment for home care under certain circumstances.  Programs include Aid & Attendance benefits, Housebound benefits, Veterans Directed Care, and Homemaker and Home Health Aide Care.
  • New Jersey has instituted a program known as the Personal Preference Program (PPP).  The program is funded with Medicaid dollars, so the individual applying must be eligible for New Jersey Family Care Plan A.  To be qualified, the individual also needs to obtain a doctor’s order to receive the services and must live in a community-based residence such as a private home, apartment, or group home, and have a documented need for hands-on personal care and require personal care assistance services for at least six months.  The PPP allows the individual to choose the home care services they want and hire workers, including family members, friends, or neighbors, and to schedule the services to meet the individual’s needs.  A budget is established by one of five managed care organizations participating in the program.  These are AETNA, Amerigroup, Horizon NJ Health, United Health Care, and Well Care.  The managed care organization (MCO) makes an evaluation of the individual’s needs and establishes a budget authorizing the number of Medicaid personal care assistance (PCA) hours that the individual is eligible to receive.  The individual is then free to use the budget.  Typically purchases include the employment of individuals for personal assistance, cleaning services, errand services, and laundry services, as well as services from a home health agency, purchases of equipment such as small appliances or technology to increase independence, or the purchase of supplies and equipment not covered by Medicaid to enhance independence.

Services under the program are non-emergency.  These include help with the activities of daily living (ADLs) and with household duties essential to the patient’s health and comfort such as bathing, dressing, meal preparation, and light housekeeping.  Family members are frequently employed to provide all or some of these services.  The PPP is an alternative to traditional agency services that allows the individual greater control over the services they receive.

The PPP provides fiscal management services to assist with the financial aspects of the program, such as payroll responsibilities, bookkeeping services, processing time sheets, and issuing paychecks.  Payroll services include tax deductions, worker’s compensation and withholding obligations.  The individual is provided with detailed financial statements showing all payments and charges.

If the individual is unable to manage the responsibilities of directing and supervising their own personal care needs, an authorized representative may act on their behalf.  The authorized representative may be the legal guardian, a family member, or other individual who willingly accept responsibility for decision-making.  The authorized representative may not be the person paid to deliver the care.  The representative must be a New Jersey resident.

The financial consultant responds to critical incidents reported by the individual and assists in the resolution of problems securing care.  In addition, the consultant provides training and support services and assistance with identifying equipment needs and completes quarterly face-to-face visits to monitor progress and determine satisfaction.